Achilles tendon pain

Pain in the Achilles tendon is common, especially in middle-aged people who also exercise. The cause is partly due to wear and tear of the Achilles tendon and partly due to overload. An Achilles tendon injury can consist of inflammation in or around the Achilles tendon or a tear. In almost all cases the symptoms are severe pain. Treatment is usually aimed at strengthening the tendon.

The Achilles tendon

The Achilles tendon consists of connective tissue and is located in the lower leg. It connects the calf muscles to the heel. At the bottom the tendon is connected to the heel bone. On the other side, the Achilles tendon is connected to the calf muscles. The Achilles tendon is the largest and strongest tendon. Because it is so large, it is also very vulnerable. Great forces are exerted, especially during exercise. Runners and tennis players in particular often suffer an injury to the Achilles tendon. The function of the Achilles tendon mainly consists of stretching the foot. Children with an Achilles tendon that is too short often walk on their toes. The Achilles tendon can be lengthened through exercises, but can also shorten when used inactively.

Pain in the Achilles tendon

Pain in the Achilles tendon is most noticeable in the calf muscle. Middle-aged people and active athletes are most likely to experience this. Pain can arise as a result of inflammation or injury. The Achilles tendon can also develop small tears several times that need to be repaired. Often the patient does not notice this. Until the Achilles tendon suddenly tears completely or shows a large tear.


An Achilles tendon injury is often caused by excessive forces on the Achilles tendon or by long-term overload. This often involves sports such as tennis, football, running and jumping. The injury can be in the Achilles tendon itself or at the attachment to the calf muscles or the heel bone. An injury causes pain, swelling and loss of strength.


Inflammation of the Achilles tendon causes pain when walking, especially when pushing off the foot. The calf may be a bit thicker than normal. In the beginning there is stiffness and fatigue in the Achilles tendon immediately after exercise. These complaints disappear again after a few hours. Then pain and stiffness occurs at the beginning of exercise but disappears halfway through. After exercising it comes back on and this now lasts longer than in the beginning. Ultimately, exercise is no longer possible and the pain only disappears after a long period of rest. If the inflammation continues, the pain remains continuous, even when the Achilles tendon is not loaded.
The cause can be found in overload of the Achilles tendon. This can be caused by sports, but also by an incorrect position of the foot, ankle or knee, which puts too much pressure on one side of the Achilles tendon. If this is prolonged, the Achilles tendon becomes irritated and can eventually become inflamed.

Torn Achilles tendon

The Achilles tendon can tear. This can be a complete or incomplete tear. Tearing the tendon feels like being kicked hard on the calf. Sometimes it is even audible. The calf swells and it is impossible to bring the toes towards the knee or to stand on the toes. This is very painful. When the tendon is completely torn, the pain may be partially eliminated. As a result, a complete tear (rupture) is not always immediately noticed. By lying on your stomach and having someone squeeze the calf, you can check whether the tendon is completely torn. If the foot does not move during the squeeze, the tendon is completely torn. If it is not completely torn, the foot moves.
The cause of a ruptured Achilles tendon is heavy overload. This occurs during sports, but also due to old age, which causes the tendon to wear out. A combination of both, sports in middle age or older age, increases the risk of rupture of the Achilles tendon. Often the Achilles tendon has already been damaged several times before the actual tear. This has created weak spots that can easily tear.

Cracking sound from the Achilles tendon

Sometimes a cracking sound is heard while walking, coming from the Achilles tendon. The tendon sheath is located around the Achilles tendon. When it becomes inflamed, it produces a cracking or crackling sound when walking. If the inflammation continues and becomes chronic, adhesions develop. This causes local thickening. The cause of an inflamed tendon sheath is overload.
Sometimes Achilles tendon pain is also caused by another disease or condition such as Freiberg’s disease or exostosis.


In all forms of Achilles tendon pain, there is one exercise that makes a lot of progress and healing. Stand on an elevated surface, such as a stair step. Stand on the ball of the foot, the heel hanging over the step. Lower the foot as far as possible. Then stand on your toes. Repeat this 10 to 15 times in one series. Do two to three series of these exercises. Twice a day, seven times a week, for 10 to 12 weeks. The physiotherapist can possibly help with this. Massage can also be applied.
Anti-inflammatories do not work sufficiently for Achilles tendonitis. An analgesic is sufficient to ensure that the Achilles tendon is trained. Cooling prevents swelling and relieves pain. In most cases, a ruptured Achilles tendon requires surgical intervention. The tear is stitched so that it can heal again. This heals better after surgery than without surgery. This reduces the chance of a new crack. However, a cast must be worn for 4 to 6 weeks for the procedure to be completely successful.

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  • Child walks on toes
  • Freiberg’s disease
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